Endovascular stroke treatment in a small‐volume stroke center

Abstract

IntroductionOur purpose was to evaluate the safety and efficacy of endovascular treatment (EVT) of stroke caused by large vessel occlusions (LVO) performed by general interventional radiologists in cooperation with stroke neurologists and neuroradiologists at a center with a limited annual number of procedures. We aimed to compare our results with those previously reported from larger stroke centers.Patients and MethodsA total of 108 patients with acute stroke due to LVO treated with EVT were included. Outcome was measured using the modified Rankin scale (mRS) at 90 days. Efficacy was classified according to the modified thrombolysis in cerebral infarction (mTICI) scoring system. Safety was evaluated according to the incidence of procedural complications and symptomatic intracranial hemorrhage (sICH).ResultsMean age of the patients was 67.5 years. The median National Institutes of Health Stroke Scale (NIHSS) on hospital admission was 17. Successful revascularization was achieved in 76%. 39.4% experienced a good clinical outcome (mRS<3). Intraprocedural complications were seen in 7.4%. 7.4% suffered a sICH. 21.3% died within 3 months after EVT.DiscussionThe use of general interventional radiologists in EVT of LVO may be a possible approach for improving EVT coverage where availability of specialized neurointerventionalists is challenging. EVT for LVO stroke performed by general interventional radiologists in close cooperation with diagnostic neuroradiologists and stroke neurologists can be safe and efficacious despite the low number of annual procedures.

Thrombectomy-Capable Stroke Centre—A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab

“…TCSC would enjoy inherited PSC's short time to IVT and bring MT closer to the patients, thus eliminating transfer delays. It is by no means a new concept since the creation of TCSC has been postulated and introduced throughout the world [6,10,11,25,39]. According to recent research, TCSC teams performing above 35 MT per year (15 MT per operator) achieve excellent results, and in the US, they are called 'high volume' [6].…”

“…The mothership model provides faster access to invasive treatment but requires the investment in new MT-capable centres and the training of new teams. Since the number of neurointerventional MT operators is highly unsatisfactory, structured training schemes should be introduced, including specialists from different backgrounds with endovascular experience [11,39,[47][48][49][50][51].…”

The Role of Interventional Radiologists in Acute Ischemic Stroke Interventions: A Joint Position Statement from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiology Society of Europe, and the Interventional Radiology Society of Australasia

“…Results from individual hospital case series of EVT performed by interventional radiologists have demonstrated outcomes comparable to those of international trials (39)(40)(41)(42)(43)(44). At present, there are no publications including the Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) data that show different outcomes associated with interventional radiologists compared with neurointerventionists (4,45).…”

Acute ischemic stroke treatment model for Poland in the mechanical thrombectomy era – which way to go?

“…A decentralized system would be based on 3 to 5 Thrombectomy-Capable Stroke Centers per region (voivodship) with crucial MT services brought closer to a patient's location, thus mitigating the weaknesses of a centralized system with long transport time. Locally available operators after proper mechanical thrombectomy training would provide treatment for acute ischemic stroke with LVO [16,[22][23][24][25][26]. This model would not only efficiently shorten the crucial time to reperfusion but also prevent undesired patient accumulation observed in sparse CSCs today.…”